Watch More! Unlock the full videos with a FREE trial
Add to Study plan
Master
Included In This Lesson
Study Tools
Hemophilia (Picmonic)
Hemophilia Pathochart (Cheat Sheet)
Example Care Plan_Hemophilia (Cheat Sheet)
Blank Nursing Care Plan_CS (Cheat Sheet)
Access More! View the full outline and transcript with a FREE trial
Transcript
We are going to focus on a care plan based on hemophilia. The pathophysiology behind hemophilia is that it's a genetic bleeding disorder that is characterized by a deficiency in clotting protein. Patients with hemophilia experience longer bleeding times than others because their blood clots much slower. The amount of clotting protein available in the blood determines the severity of the hemophilia. It is categorized into three different levels. There's mild, moderate, and severe complications of the disease including bleeding into the joints, hemorrhage into the central nervous system or the vital organs, and aspiration from bleeding until the air res. Some of the things we want to consider as nurses is we want to assess the patient for bleeding. We want to get those bleeding precautions initiated. We want to assess the stool and urine for blood, and we want to assess and manage pain. Our desired outcome for this patient population is that the patient is going to be free of infection. We're going to manage and reduce the pain and inflammation, regain optimum mobility and prevent complications from bleeding.
These patients with hemophilia are very irritable during their events; that can mean a variety of things, but with this particular patient population, they are irritable. They also have pain and tightness in their joints. They always complain of pain or tightness, and that's primarily because these patients are susceptible to blood pooling into their joints. They're typically sleepy and lethargic. They have double vision. And some of the objective data that we might observe are deep or large bruises. These patients tend to have unexplained nosebleeds. They may have blood in the urine or stool, and they may have excessive bleeding from cuts or after dental work. So excessive bleeding. Okay. As nurses, there are a few interventions that we can do. The first thing we want to look at is we want to assess the patient for any type of signs of bleeding, whether it be by cuts, scrapes, bruises, or in it's swollen joints. Deep bruising may lead to bleeding in joint spaces and other vital organs. So, we want to do an assessment of that. We want to assess for bleeding.
The next thing that we could do is initiate those bleeding precautions because these patients, if left in the right circumstances will bleed. So, we want bleeding precautions. A small injury that will cause a normal person no harm can make this patient bleed excessively. So we want to be careful of that. We also want to avoid any unnecessary invasive techniques. So this kind of leads into the blending precautions. We want to avoid heel and finger sticks, we want to avoid IM injections, if at all possible. Be prepared for excessive bleeding. When we administer vaccines, we can try to opt for sub Q routes when those are available as well. Be sure that with these patients, that we apply pressure to any site for several minutes to allow time to clot, because they take a lot longer to do that.
One of the treatments for hemophilia is more of a therapeutic and that is when we administer replacement clotting factors. So, that's the next goal of ours; we want to replace clotting factors and that's just an infusion that we can give IV. Replacing clotting factors is the primary treatment for hemophilia. Other supplements, antibodies, and antifibrinolytics may be required for this patient population. We're going to monitor the coagulation tests. We're going to look at their hemoglobin and hematocrit levels because we need to know if this patient is bleeding. We need to know where they're bleeding. So, we want to do hemoglobin and hematocrit. We want to monitor the effectiveness of the interventions and the therapeutic levels of the medication; expect bleeding times to be reduced from the patient's baseline. So, we're going to also look at the PT, PTT, INR. Just like I said, different bleeding and coagulation blood levels that we're going to monitor.
Finally with this patient, let's focus on pain. We are going to assess the patient for evidence of pain, but very specific pain. We are looking at pain that is showing up in the joints or muscles. Patients often report very painful joints or aching muscles. And again, that's due to the blood that pools, maybe they bumped their elbow somewhere. And where on the surface, you may not see anything internally. There could be blood pooling into those joints causing pain. So the key points that I want you all to focus on for hemophilia is that hemophilia is a genetic bleeding disorder characterized by a deficiency in the clotting proteins. The subjective data that the patient is going to present is they're going to be irritable. They're going to have some joint pain. They may be sleepy,lethargic, and they may have some double vision.
Well, we're going to be able to see in the patient, our objective data that we're going to have, is there is going to be some blood and urine or stool. They may have some large or deep bruises and some unexplained nosebleeds, small and simple injuries. We're going to put them at a bleeding risk. I'm going to put them on bleeding precautions, because like I said, small and simple injuries can cause excessive bleeding, bleeding precautions, and we want to avoid any unnecessary lab sticks or insertions. We want to make sure we replace their clotting factors. Remember clotting factors are the only way to treat these patients. It's the main treatment that these patients will receive. Remember that there are two different types of hemophilia and depending on which type A or type B it would depend on what clotting factor is needed. And lastly, we love you guys; go out and be your best self today. And, as always, happy nursing.
These patients with hemophilia are very irritable during their events; that can mean a variety of things, but with this particular patient population, they are irritable. They also have pain and tightness in their joints. They always complain of pain or tightness, and that's primarily because these patients are susceptible to blood pooling into their joints. They're typically sleepy and lethargic. They have double vision. And some of the objective data that we might observe are deep or large bruises. These patients tend to have unexplained nosebleeds. They may have blood in the urine or stool, and they may have excessive bleeding from cuts or after dental work. So excessive bleeding. Okay. As nurses, there are a few interventions that we can do. The first thing we want to look at is we want to assess the patient for any type of signs of bleeding, whether it be by cuts, scrapes, bruises, or in it's swollen joints. Deep bruising may lead to bleeding in joint spaces and other vital organs. So, we want to do an assessment of that. We want to assess for bleeding.
The next thing that we could do is initiate those bleeding precautions because these patients, if left in the right circumstances will bleed. So, we want bleeding precautions. A small injury that will cause a normal person no harm can make this patient bleed excessively. So we want to be careful of that. We also want to avoid any unnecessary invasive techniques. So this kind of leads into the blending precautions. We want to avoid heel and finger sticks, we want to avoid IM injections, if at all possible. Be prepared for excessive bleeding. When we administer vaccines, we can try to opt for sub Q routes when those are available as well. Be sure that with these patients, that we apply pressure to any site for several minutes to allow time to clot, because they take a lot longer to do that.
One of the treatments for hemophilia is more of a therapeutic and that is when we administer replacement clotting factors. So, that's the next goal of ours; we want to replace clotting factors and that's just an infusion that we can give IV. Replacing clotting factors is the primary treatment for hemophilia. Other supplements, antibodies, and antifibrinolytics may be required for this patient population. We're going to monitor the coagulation tests. We're going to look at their hemoglobin and hematocrit levels because we need to know if this patient is bleeding. We need to know where they're bleeding. So, we want to do hemoglobin and hematocrit. We want to monitor the effectiveness of the interventions and the therapeutic levels of the medication; expect bleeding times to be reduced from the patient's baseline. So, we're going to also look at the PT, PTT, INR. Just like I said, different bleeding and coagulation blood levels that we're going to monitor.
Finally with this patient, let's focus on pain. We are going to assess the patient for evidence of pain, but very specific pain. We are looking at pain that is showing up in the joints or muscles. Patients often report very painful joints or aching muscles. And again, that's due to the blood that pools, maybe they bumped their elbow somewhere. And where on the surface, you may not see anything internally. There could be blood pooling into those joints causing pain. So the key points that I want you all to focus on for hemophilia is that hemophilia is a genetic bleeding disorder characterized by a deficiency in the clotting proteins. The subjective data that the patient is going to present is they're going to be irritable. They're going to have some joint pain. They may be sleepy,lethargic, and they may have some double vision.
Well, we're going to be able to see in the patient, our objective data that we're going to have, is there is going to be some blood and urine or stool. They may have some large or deep bruises and some unexplained nosebleeds, small and simple injuries. We're going to put them at a bleeding risk. I'm going to put them on bleeding precautions, because like I said, small and simple injuries can cause excessive bleeding, bleeding precautions, and we want to avoid any unnecessary lab sticks or insertions. We want to make sure we replace their clotting factors. Remember clotting factors are the only way to treat these patients. It's the main treatment that these patients will receive. Remember that there are two different types of hemophilia and depending on which type A or type B it would depend on what clotting factor is needed. And lastly, we love you guys; go out and be your best self today. And, as always, happy nursing.
View the FULL Transcript
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
“Would suggest to all nursing students . . . Guaranteed to ease the stress!”
